DISASTER NURSING AND EMERGENCY PREPAREDNESS: FOR CHEMICAL, BIOLOGICAL, AND RADIOLOGICAL TERRORISM, AND OTHER HAZARDS, 4TH EDITION
Thermal injury continues to be a major cause of morbidity and mortality in the United States. In 2013, fire killed more Americans than all natural disasters combined, with over 3,400 deaths and nearly 16,000 injured. Fire loss rates have been trending down over the last decade; however, the United States is still ranked as having the twelfth-highest fire death rate of the 28 industrialized countries examined by the World Fire Statistics Centre. Death rates vary from state to state based on climate differences as well as socioeconomic, educational, and other factors (United States Fire Administration [USFA], www.usfa.fema.gov).According to the ABA, the definition of a "burn MCI" is any catastrophic event in which the number of burn victims exceeds the capacity of the local burn center to provide optimal care. Up to 30% of casualties from historic MCIs have required burn care, with 10% being burn-only injuries and the remaining 20% being a combination of burns and other trauma. The etiology of these incidents may be natural or man made, intentional or accidental. They can occur with industrial accidents, structural fires or collapses, terrorist attacks, mass transit accidents, earthquakes, wildfires, or other catastrophic events. Burn-patients may constitute a small percentage of the total number of people injured, but this group consumes a disproportionately large amount of healthcare resources compared to a nonburned trauma patient. For example, of those injured at the World Trade Center on 9/11, massive traumatic injuries were associated with imminent mortality and the walking wounded were treated and released. Burn patients, however, remained hospitalized for several months after the event and exhausted the local healthcare system (American Burn Association Board of Trustees and the Committee on Organization and Delivery of Burn Care, 2005).It does not take a nationally publicized event to seriously impact a healthcare system; even a local apartment fire can cause a regional hospital system to exceed its surge capacity. A burn center's capacity is determined by available burn beds, burn surgeons, burn nurses, support staff, operating rooms, equipment, supplies, and related resources; it is a dynamic number. "Surge capacity" is the ability to evaluate and treat up to 50% more patients than the normal burn patient census when there is an emergency. "Sustained surge capacity" is the ability of the burn center to care for these increased numbers of patients throughout their entire hospital course. There is a critical difference in these two numbers. Often a burn center can surge to meet the immediate patient needs after a disaster but lacks the personnel and other resources to sustain this surge. They may need to quickly off-load patients to other care facilities. It is important to note that surge capacity is different at each burn center and may vary day to day.The disaster life cycle for a mass burn casualty incident is similar in structure to all other disasters. This chapter will discuss preparedness, mitigation, response, recovery, and evaluation. It is imperative that disaster planners, first responders, and clinicians understand principles of burn disasters to be able to plan and implement an effective management strategy. Also, an understanding of burn care is needed to be able to make decisions regarding triage, transport, and treatment. In addition to restoring damaged infrastructure and initiating psychiatric follow-up, the recovery phase should lead into a thorough evaluation of the response. The evaluation should generate recommendations for revision of the disaster plan for future use.